eMedicine Specialties > Urology > Hydronephrosis and Ureter Disorders

Hydronephrosis and Hydroureter: Treatment & Medication

Author: Srinivas Vourganti, MD, Staff Physician, Department of Urology, Case Western Reserve University, University Hospitals of Cleveland
Coauthor(s): Prakash Maniam, MD, Staff Physician, Department of Urology, St Mary's Hospital of Troy
Contributor Information and Disclosures

Updated: Feb 25, 2008

Treatment

Medical Care

The role of medical treatment of hydronephrosis and hydroureter is limited to pain control and treatment or prevention of infection. Most conditions require either minimally invasive or open surgical treatment. Two notable exceptions are (1) oral alkalinization therapy for uric acid stones and (2) steroid therapy for retroperitoneal fibrosis.2

Surgical Care

The specific treatment of a patient with hydronephrosis and hydroureter depends, of course, on the etiology of the process. Several factors help determine the urgency with which treatment should be initiated. In general, any signs of infection within the obstructed system warrant urgent intervention because infection with hydronephrosis may progress rapidly to sepsis. A mildly elevated white blood cell count is often observed in patients with stones but does not necessarily mandate immediate action in the absence of other signs or symptoms of systemic infection. However, even a low-grade fever in a diabetic or immunosuppressed patient (ie, on steroid therapy) requires immediate treatment.

The potential for loss of renal function also adds to the urgency (eg, hydronephrosis or hydroureter bilaterally or in a solitary kidney). Finally, patient symptoms help determine the urgency with which treatment is initiated. For example, refractory pain in a patient with an obstructing ureteral calculus necessitates intervention, as does intractable nausea and vomiting.

  • Urethral catheterization is important to help rule out a lower tract cause for hydronephrosis and hydroureter. Difficulty in placing a Foley catheter may suggest urethral stricture or bladder neck contracture.
  • Urologists commonly use ureteral stent placement in cases of intrinsic and extrinsic causes of hydronephrosis. The procedure is usually performed in conjunction with cystoscopy and retrograde pyelography. Stents can bypass an obstruction and dilate the ureter for subsequent endoscopic treatment.
  • Urologists or interventional radiologists can place a percutaneous nephrostomy tube. Usually, ultrasonography is used first to locate the dilated collecting system. Using the Seldinger technique, a tube ranging from 8-12F can be placed. Nephrostomies are typically placed when a retrograde stent cannot be passed because of anatomic changes in the bladder or high-grade obstruction in the ureter. Because this procedure can be performed under local anesthesia, patients who are too hemodynamically unstable for general anesthesia may undergo percutaneous nephrostomy tube placement. In addition, nephrostomy tube placement may be performed with minimal use of radiation and may be useful in pregnant patients.
  • Advances in endoscopic and percutaneous instrumentation have decreased the role of open or laparoscopic surgery for hydronephrosis. Certain causes of hydronephrosis, mostly extrinsic, still require treatment with open surgery. Examples include retroperitoneal fibrosis, retroperitoneal tumors, and aortic aneurysms. Some stones that cannot be treated endoscopically or with extracorporeal shockwave lithotripsy require open removal. Although endoscopic management does play a role in low-grade low-stage ureteral tumors, these lesions also usually require open or laparoscopic surgical management.
  • Urine should be collected from the kidney when obstruction is relieved to allow identification and targeted treatment of any infection that may be present.

Consultations

Refer the patient to a urologist whenever hydronephrosis or hydroureter is newly diagnosed. Further consultations may be sought by the urologist, depending on the circumstances. For example, a nephrologist's input would be useful in cases of severe pathological postobstructive diuresis. Also, an interventional radiologist would be needed for nephrostomy tube placement if urgent decompression is needed and ureteral stent placement is not possible.

More on Hydronephrosis and Hydroureter

Overview: Hydronephrosis and Hydroureter
Differential Diagnoses & Workup: Hydronephrosis and Hydroureter
Treatment & Medication: Hydronephrosis and Hydroureter
Follow-up: Hydronephrosis and Hydroureter
References
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References

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Further Reading

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Keywords

hydronephrosis, hydroureter, urinary tract obstruction, renal pelvis dilation, calyces dilation, hydroureteronephrosis, hydronephrotic system, pyonephrosis, urine flow interruption, interrupted urine flow, pyelolymphatic backflow, renal colic, advanced pelvic malignancy, prostatic hypertrophy, prostate cancer, cervical cancer, pregnancy, ureter calculi, ureteral calculi, ureteropelvic junction obstruction, UPJ obstruction, urine reflux, postobstructive diuresis

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Contributor Information and Disclosures

Author

Srinivas Vourganti, MD, Staff Physician, Department of Urology, Case Western Reserve University, University Hospitals of Cleveland
Disclosure: Nothing to disclose.

Coauthor(s)

Prakash Maniam, MD, Staff Physician, Department of Urology, St Mary's Hospital of Troy
Prakash Maniam, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction
Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director of the Lorain Kidney Stone Research Center, Clinical Assistant Professor, Department of Urology, Medical College of Ohio
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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